title: Multicenter study comparing shunt type in the norwood procedure for single-ventricle lesions: three-dimensional echocardiographic analysis.
abstract: BACKGROUND
  The Pediatric Heart Network's Single Ventricle Reconstruction (SVR) trial randomized infants with single right ventricles (RVs) undergoing a Norwood procedure to a modified Blalock-Taussig or RV-to-pulmonary artery shunt. This report compares RV parameters in the 2 groups using 3-dimensional echocardiography.
  
  
  RESULTS
  Three-dimensional echocardiography studies were obtained at 10 of 15 SVR centers. Of the 549 subjects, 314 underwent 3-dimensional echocardiography studies at 1 to 4 time points (pre-Norwood, post-Norwood, pre-stage II, and 14 months) for a total of 757 3-dimensional echocardiography studies. Of these, 565 (75%) were acceptable for analysis. RV volume, mass, mass:volume ratio, ejection fraction, and severity of tricuspid regurgitation did not differ by shunt type. RV volumes and mass did not change after the Norwood, but increased from pre-Norwood to pre-stage II (end-diastolic volume [milliliters]/body surface area [BSA](1.3), end-systolic volume [milliliters]/BSA(1.3), and mass [grams]/BSA(1.3) mean difference [95% confidence interval]=25.0 [8.7-41.3], 19.3 [8.3-30.4], and 17.9 [7.3-28.5], then decreased by 14 months (end-diastolic volume/BSA(1.3), end-systolic volume/BSA(1.3), and mass/BSA(1.3) mean difference [95% confidence interval]=-24.4 [-35.0 to -13.7], -9.8 [-17.9 to -1.7], and -15.3 [-22.0 to -8.6]. Ejection fraction decreased from pre-Norwood to pre-stage II (mean difference [95% confidence interval]=-3.7 [-6.9 to -0.5]), but did not decrease further by 14 months.
  
  
  CONCLUSIONS
  We found no statistically significant differences between study groups in 3-dimensional echocardiography measures of RV size and function, or magnitude of tricuspid regurgitation. Volume unloading was seen after stage II, as expected, but ejection fraction did not improve. This study provides insights into the remodeling of the operated univentricular RV in infancy.
authors.affiliation: Boston Children's Hospital, MA.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Marx
authors.forename: Girish
authors.initials: G
authors.lastname: Shirali
authors.forename: Jami C
authors.initials: JC
authors.lastname: Levine
authors.forename: Lin T
authors.initials: LT
authors.lastname: Guey
authors.forename: James F
authors.initials: JF
authors.lastname: Cnota
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Baffa
authors.forename: William L
authors.initials: WL
authors.lastname: Border
authors.forename: Steve
authors.initials: S
authors.lastname: Colan
authors.forename: Gregory
authors.initials: G
authors.lastname: Ensing
authors.forename: Mark K
authors.initials: MK
authors.lastname: Friedberg
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.forename: Salim F
authors.initials: SF
authors.lastname: Idriss
authors.forename: J Blaine
authors.initials: JB
authors.lastname: John
authors.forename: Wyman W
authors.initials: WW
authors.lastname: Lai
authors.forename: Minmin
authors.initials: M
authors.lastname: Lu
authors.forename: Shaji C
authors.initials: SC
authors.lastname: Menon
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.forename: David
authors.initials: D
authors.lastname: Saudek
authors.forename: Pierre C
authors.initials: PC
authors.lastname: Wong
authors.forename: Gail D
authors.initials: GD
authors.lastname: Pearson
mesh_terms: D002675:Child, Preschool; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D058327:Norwood Procedures / Q000379:methods*; D011651:Pulmonary Artery / Q000601:surgery*; D016896:Treatment Outcome
keywords: echocardiography; heart defects, congenital; pediatrics